CDH-ECMO Routine Patient Preoperative Workup, Timing, Technique: Update...

Echocardiography and TR jet measurement are essential for assessing pulmonary hypertension in CDH patients, as pre- and post-ductal saturations alone are insufficient to determine the degree of pulmonary hypertension.

Surgical repair should be delayed until pulmonary pressures are subsystemic, ideally at 70% systemic or lower, preferably 50% systemic.

Aggressive monitoring with echocardiography should be performed before proceeding to the operating room, with no rush to operate.

Thoracoscopy is preferred for CDH repair in well-managed patients.

Laparoscopic CDH repair can produce good results, but thoracoscopy is considered an easier operation.

Dissecting out the pleura to create a raw edge around the hernia defect may reduce recurrence, analogous to avoiding sewing peritoneum to peritoneum in laparoscopic inguinal hernia repair.

Sewing pleura to pleura without creating a raw edge may have a failure rate similar to laparoscopic inguinal hernia repair when sewing peritoneum to peritoneum.

An animal model study using lambs to investigate pleural dissection technique in CDH repair would cost $5000 per lamb, making it financially prohibitive.